EMOTION REGULATION AND ITS

ROLE IN SELF-INJURIOUS

BEHAVIORSAmanda Gutierrez, Psy. D

Licensed Clinical Psychologist

PSY23873

LECTURE OBJECTIVES

� 1- Discuss Emotions and their function.

� 2- Discuss the cycle for explaining emotions.

3- Discuss non-suicidal self-injury, parasuicidal� 3- Discuss non-suicidal self-injury, parasuicidal

behaviors and their function.

� 4- Discuss skills to regulate emotions.

WHAT ARE EMOTIONS?

� Definition- notoriously difficult due to the

variations in conceptualization of the mind-body

connection.

� For the purpose of this presentation and based

out of a Dialectical Behavioral Theory:out of a Dialectical Behavioral Theory:

� Emotions are particular types of patterned

reactions to events” –Linehan, 1993

� Emotions are a psychophysiological experience of

an individuals state of mind that interact with

biochemical (internal) and environmental

(external) factors.

IMPORTANT DISTINCTIONS

� Emotion versus the behavioral result of the

emotion- mainly the emotion and the expression

of the emotion

� Example- Anger: if someone is hitting and screaming

we might say “that person is very angry”. we might say “that person is very angry”.

� This is inaccurate- at the point of the behavioral

reaction the person is now expressing the emotion

and doing so inappropriately.

� People often behave in ways that are in direct result

of the emotion they experience :

� Crying, pacing, screaming, etc.

IMPORTANT DISTINCTION

� Emotion Versus Feeling:

� Feeling are perceptions about things, people and

situations.

� You can have feelings about the emotions you

experience. experience.

� “I am not feeling well today”, “I don’t feel right about this

situation”

� You have different parts of the brain that lead to

emotional states and different parts of the brain that

lead to feelings about these states.

� A case in point: A fMRI study showed that when subjects

experienced the emotion of sadness, certain brain areas

became activated, yet when they formed a feeling about

their sadness, other brain domains were aroused.

WHERE DO OUR EMOTIONS COME FROM?

� We are all born with a standard set of emotions

that are universal and are seen across cultures.

� Happy Fear Anger Shame

(varies)

Sad Surprise Disgust Sad Surprise Disgust

MODEL FOR DESCRIBING EMOTIONS

Interpretation of Event

•Automatic thought•Belief

Prompting Event•Internal•External

Emotion•Neurochemicalbrain change•Face and body change•Sensing•Action urge

Behavior•Face and body language•Action •Expression with words

Aftereffects•Physical functioning•Memory and concentration•Thoughts

EMOTIONAL URGES

� Along with basis emotions ALL of our emotions

have universal innate urges and are seen across

the animal kingdom

Emotion Innate Urge Human

Behavior

Animal

BehaviorBehavior Behavior

Anger Attack Yell/hit Snap/bite

Sadness Withdraw Isolate Hide

Fear Fight/Flight Run/Attack Run/Attack

Surprise Fight/Flight Gasp/Jump Flinch/Run

Disgust Retreat Facial

expression

Turn head

away

Shame Hide Head down Tail down,

hide

WHY CANT I GET RID OF THE EMOTIONS

THAT I DON’T WANT???

� All emotions serve a function that is necessary

for survival.

� MOTIVATE AND ORGANIZE ACTION

� Emotions have hard-wired urges� Emotions have hard-wired urges

� Emotions save us time when we need to act in

important situations.

� Important when we don’t have time to think

� Can help us overcome obstacles

EXAMPLE: A BEAR WALKS IN RIGHT NOW!

What would you feel? What would you do? What would you NOT do?

EMOTIONS COMMUNICATE TO AND

INFLUENCE OTHERS

� Facial expressions are a hard-wired part of

emotions

� Facial expressions communicate faster than

words

� Non-verbal expression is at least 70% of how we � Non-verbal expression is at least 70% of how we

communicate.

� When it is important to communicate something

to others it is very hard to change our emotions

� Whether planned or not, the communication of

emotions influence others.

EXAMPLE

“Im FINE!” Nothing is

wrong AT ALL!

What are you laughing

at??

EMOTIONS COMMUNICATE TO OURSELVES

� Emotional Reactions can give us important information about a situation

� Gut feelings can be like intuition that there is something we need to consider about the situation

Help us check the facts of the situation � Help us check the facts of the situation

� Problems arise when we treat emotions as facts

� Stronger the emotion the more directly we relate it to absolute fact.

� “Because I feel nervous, I must be incompetent”.

� “I feel very confident about this! It must be right”!

� “Because I love him/her, then the relationship must be ok”

HOW DO WE REGULATE OUR EMOTIONS?

Autonomic Nervous System-

Like it sounds this is a biological system that

functions automatically.

� Sympathetic Nervous System- Activated- fight, flight,

freezefreeze

� Occurs during the “in breath”

� Parasympathetic Nervous System- Calms system

down- time to relax

� Occurs during the “out-breath”-

� Hence why deep breathing works.

REGULATING EMOTIONS

� We are all born with the ability to regulate our

emotions.

� Sucking reflex- breast feeding/thumb sucking

FACTORS THAT REDUCE EMOTION

REGULATION

� Biology – spectrum of emotional sensitivity

� Lack of Skill- Never learned what to do with “negative emotions”.

� Reinforcement of Emotional Behavior- when your highly emotional your environment reinforces you. emotional your environment reinforces you.

� Moodiness- mood not skills take control

� The Emotional Sea of Dyscontrol – feel like you are drowning in intense emotions

� Emotion Myths – emotions are bad/weak or extreme emotion are “part of who you are”.

HOW DO OUR EMOTIONS GET

DYSREGULATED ?

� Although our emotions have a natural ½ life, on

average 5-10 minutes, they can be maintained for

a longer duration by:

� Thoughts� Thoughts

� Behaviors

� Aftereffects

_________________ Baseline_________________

EXAMPLE OF UN-NATURAL EMOTION

REGULATION….

� Anyone need a smoke break??

� ACh or Acetylcholine is our brains natural

chemical that promotes emotion regulation.

� Nicotine mimics ACh in the brain and un-

naturally regulates emotions. naturally regulates emotions.

� This is why you may feel more relaxed after a

cigarette OR may crave cigarettes in highly

emotional states; stressed, sad, anxious AND

may even feel some relief.

� BE AWARE… it’s a TRICK!!

EMOTION DYSREGULATION

� It is unnatural for our bodies to stay in an activated state for longer then is needed to serve the emotions function.

� This is seen in prolonged anxiety disorders. Our bodies actually develop illnesses due to the sympathetic nervous system being overly activated. sympathetic nervous system being overly activated. � High Blood pressure

� Heart disease

� High Cholesterol

� Some people learn how to regulate their emotions in unhealthy ways.

SELF-HARM AND OTHER NON-

SUICIDAL BEHAVIORS

NON-SUICIDAL SELF-INJURY AND

PARA-SUICIDAL BEHAVIORS

� Definition- any behavior of which the intention is not suicide but in turn could result in death or severe injury/damage.

� These behaviors include but are not limited to

� Self-mutilation- cutting/scratching/burning

Excessive substance use- drinking/drugs/combination � Excessive substance use- drinking/drugs/combination

� Eating disordered behaviors

� Reckless Driving

� Unprotected Sex

� Physical fights

� For the purposes of this lecture we will refer to all of these behaviors as “self-harm”.

MYTHS ABOUT SELF-HARM

1-If the wound isn’t that bad then the problem isn’t that serious.

2- People that self injure need to be committed to psychiatric facilities

3- Its only attention seeking behavior

4- Its used to manipulate others4- Its used to manipulate others

5- Self-harmers are dangerous to others

6- They do not feel the pain

7- Self-injury is a personality disorder

8- Only teenage girls self-injure

9- Self-injury is always an unsuccessful suicide attempt

10- There is nothing you can do to help someone that self- injures.

SELF-INJURY VERSUS SUICIDE

“a person who truly attempts suicide seeks to

end all feelings whereas a person who self

mutilates seeks to feel better”mutilates seeks to feel better”

~Favazza

WHY IT WORKS

� Self-injury works because it reduces tension and

restores a sense of psychological equilibrium

� Helps a dysregulated person return to their emotional baseline

� Self-injury has powerful communication aspects

� “I am in pain” and/or “ please understand my pain”

� “I am in need and don’t know how to ask for it/or don’t think I deserve it” etc

� Self-injury provides a sense of control and empowerment

� In chaotic or invalidating environments.

VULNERABILITIES TO SELF-HARM

� Depression (labile emotion, irritability, loneliness, isolation, hopelessness)

� Anxiety (weak coping and/or social skills)

� Impulsivity

� Low self-esteem

� Perfectionism� Perfectionism

� Confused sense of self (including sexual orientation)

� Internal locus of control (self-blame)

� Awareness of self-harm by peers/family

� Impaired family communication

� Hypercritical environment

� Violent/dysfunctional family

� Use of cigarettes, alcohol, & drugs

� Criminal history

COMMON CHARACTERISTICS OF PEOPLE

WHO SELF-HARM

� Interpersonal Chaos

� Labile Affect/ Emotional dysregulation

� Impulsiveness� Impulsiveness

� Confusion about Self

� Emotional Vulnerability- highly sensitive, highly reactive, slow return to baseline.

� Invalidating Environment

INVALIDATING ENVIRONMENT

� Usually starts in childhood/family of origin

� “Poorness of fit”- temperaments/personality

� Child’s expression of private experiences are dismissed

� Child’s expression of private experiences are dismissed

� “Your not sad, you have no reason to be sad!”

� Child learns to distrust internal cues

� “This is normal/safe/love”- when being mistreated

� Child “ups the volume” to convince others that what they’re feeling is real.

REASONS THAT PEOPLE SELF HARM

� To stop bad feelings

� To feel something, even if pain/to relieve feeling numb or empty

� To punish self

� To feel relaxed� To feel relaxed

� To give self something to do when alone

� To communicate to someone, even if response is negative/not desired

� To feel self-control over a situation

� To ask for help

� To feel more a part of a group (more often seen in teens)

FUNCTIONS OF SELF HARM

� Automatic-negative Reinforcement:

to stop bad feelings

� Automatic-positive Reinforcement:

� to feel something� to feel something

� Social-negative Reinforcement:

� to avoid doing something unpleasant and unable to express

needs or lack of desire assertively.

� Social-positive Reinforcement:

� to communicate to others needs/wants and get a response.

EMOTION REGULATION SKILLS

BALANCING EMOTIONAL VULNERABILITY

PLEASE SKILL

� Taking care of your body=taking care of your mind.

� PL- Taking care of any physical illnesses; including

chronic pain.

� E- Balanced eating- not too much or too little. Consult

the food pyramid. Omega-3 rich foods. Stay hydratedthe food pyramid. Omega-3 rich foods. Stay hydrated

� A- Avoid mood altering drugs/non-prescribed

drugs/alcohol. Consider caffeine intake.

� S- get amount of sleep that works for you. Keep your

sleep schedule consistent. Consult “Sleeping Healthy

Guide” if sleep is disrupted.

� E- Exercise. Work up to 20 minutes a day. Releases

the same Neurotransmitters that are found in

medications such as SSRIs (example- Prozac).

OPPOSITE TO EMOTION

� All our emotions have a natural innate

behavioral urge that it is associated to (slide #8)

� When we act in congruence with that urge the

intensity of the emotion increases.intensity of the emotion increases.

When we act opposite to the urge the intensity of

that emotion decreases.

CONGRUENT WITH THE EMOTION URGE

Sad

Sad

Isolate

OPPOSITE TO EMOTION URGE

Sad

Socialize

OPPOSITE TO ISOLATE IS……

OPPOSITE TO EMOTION STEP-BY-STEP

� 1- Identify the emotion YOU want to change

� What do I feel? What is the emotion name?”

� 2- Identify the Action Urges

� What do I want to do? Will it be helpful?

� 3- Act opposite ALL the way or it wont work� 3- Act opposite ALL the way or it wont work

� 100%- throw yourself in

� 4- Repeat until emotional sensitivity goes down

and your tendency to act on the emotion goes

down.

� Doing this will allow you the freedom to respond

versus react.

EXAMPLES OF OPPOSITE TO EMOTION

ANGER

� Anger is justified when:

� An important goal is blocked/prevented

� You or someone you care about it attacked or hurt (physically/emotionally)

� You or someone you care about is insulted or threatened by others. threatened by others.

� Acting opposite of urge to Attack (innate)

� Gently Avoid

� Do something a little bit nice

� Imagine understanding/ Use Empathy

� Relaxed posture� Willing hands

� ½ Smile

� Breath slowly deeply

MINDFULNESS OF EMOTION

� Suppressing an emotion (or trying to) only

increases suffering

� Steps 1-4

� 1- Observe your Emotion- step back and just

notice. Like a wave- coming and going.notice. Like a wave- coming and going.

� What do you notice when you take a step back?

Vs

MINDFULNESS OF EMOTION CONTINUED

2- Practice Mindfulness of your bodily sensations

-Where in your body do you feel sensations

-Experience them as fully as you can

-Observe how long it takes before the

emotion decreasesemotion decreases

3- Remember you are not your emotion

Do not necessarily have to ACT on the emotion

Remember times when you felt different

4- Practice loving your emotion

Respect your emotion/ don’t judge

Remember that your emotions have a function

Radically accept your emotion- it is what it is… cause and effect relationship

RESOURCES

� Self-Mutilation: A Helping Book for Teens Who Hurt Themselves. (1999) Alicia Clarke

� Skills Training Manual for Treating Borderline Personality Disorder. (1993) Marsha LinehanPersonality Disorder. (1993) Marsha Linehan

� Cognitive Behavioral Treatment of Borderline Personality Disorder (1993). Marsha Linehan

� Dialectical Behavior Therapy with Suicidal Adolescents (2006) Alec Miller, Jill Rathus, Marsha Linehan, & Charles Swenson

QUESTIONS, COMMENTS, FEEDBACK??

Contact Information

� Amanda Gutierrez, Psy.D

gutieramanda@gmail.com� gutieramanda@gmail.com

� Amanda.gutierrez@sharp.com

� www.dbtsandiego.com